Provider Demographics
NPI:1285517938
Name:PRIMUSU HEALTHCARE LLC
Entity type:Organization
Organization Name:PRIMUSU HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:FATIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:202-290-8763
Mailing Address - Street 1:1061 GREEN FAMILY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7788
Mailing Address - Country:US
Mailing Address - Phone:202-290-8763
Mailing Address - Fax:
Practice Address - Street 1:1061 GREEN FAMILY RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29492-7788
Practice Address - Country:US
Practice Address - Phone:202-290-8763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies